Retrospective cohort study. The aim of this study was to compare differences in postoperative readmission rates, complications, and costs for one- to two-level ACDFs among Medicare fee-for-service beneficiaries performed in an inpatient, hospital outpatient, or ASC. Anterior cervical discectomy and fusion (ACDF) is increasingly performed in the outpatient setting. There is a paucity of literature examining the safety and differences in cost of performing these procedures in the outpatient setting. Patients who underwent a primary one- or two-level ACDF from 2016 to 2021 were retrospectively identified using Current Procedural Terminology (CPT) codes. A total of 118,692 patients were included in the analysis. Demographic data, surgical characteristics, postoperative readmissions and complications, as well as cost data, were collected through the Centers for Medicare and Medicaid Services. Patients were matched by demographic, comorbidity, and surgical characteristics, and univariate analysis was performed to determine differences in outcomes by surgical setting. The proportion of Medicare patients undergoing ACDF at a hospital outpatient or ASC steadily increased from 2016 to 2021, ultimately as high as 49.2% in 2021. Total adjusted initial ("index") surgery (ASC $9898 vs. OP $13,011 vs. IP $33,911) and total 90-day episode of care costs (ASC $13,465 vs. OP $17,264 vs. IP $44,016) were significantly lower in both the ASC and outpatient cohorts compared with the inpatient cohort ( P <0.001). ACDFs performed in the ASC or outpatient setting had significantly lower rates of adjusted readmission, total complications, infection, VTE, and revision surgery ( P <0.001) compared with those in the inpatient setting. One- and two-level ACDF is increasingly being performed in an outpatient setting. Outpatient surgery is associated with lower rates of readmission, complications, and costs. By using the Medicare database and matching patients by demographic data and comorbidities, the results support that performing ACDFs at an ASC is safe. Level III.

Outpatient settings, including emergency departments, urgent care centers, and primary care clinics in underserved communities, face persistent workforce instability because of high patient volumes, limited resources, and burnout. This qualitative single-site case study explored retention strategies as perceived by Hispanic Generation Z employees working in a rural primary care clinic near the US-Mexico border. Semi-structured interviews were conducted with 12 medical assistants and analyzed using thematic analysis. Four themes influencing retention emerged: feeling appreciated and recognized, psychologically safe workplace relationships, flexibility with opportunities for professional growth, and cultural affirmation and belonging. Although conducted in an outpatient setting, the findings have conceptual relevance to the broader direct patient-care workforce. Results underscore the importance of relational, cultural, and developmental factors often overlooked in retention strategies that emphasize structural or operational solutions. Culturally responsive approaches may enhance workforce well-being, improve team stability, and support sustainable care delivery in underserved communities.

Construction and interpretability evaluation of a prediction model for radiographic pneumonia in children at outpatient and emergency departments.

Tibial access is associated with tibial intervention in claudicants.

Home exercise programs (HEPs) are beneficial for the rehabilitation process, yet adherence remains low (30%-50%). People with aphasia (PWA) face unique challenges due to deficits in language comprehension and/or expression, but research on facilitators and barriers to achieving HEP adherence in this population is limited. This study examines speech-language pathologists' (SLPs') perspectives on factors that facilitate or hinder adherence to HEPs in PWA. A 37-item cross-sectional online survey was administered to SLPs treating PWA. A nonprobability purposive sampling method was used. Likert scale responses were analyzed using descriptive statistics and Spearman rho correlations. Open-ended questions were analyzed for patterns and themes. Of 100 responses, 83 completed surveys were analyzed. Participants were primarily female (~93%) practicing in outpatient settings, with over 21 years of experience. Key facilitators to HEP adherence included motivation (98%), caregiver integration (96%), and incorporating the HEP into daily routines (90%). Moderate positive correlations were found between integrating HEPs into daily routines and perceived relevance (rs = .500, p < .001), as well as between caregiver involvement and HEP integration into daily life (rs = .502, p < .001). Facilitators were categorized as internal (motivation, relevance) and external (family and SLP support). Barriers included internal factors (depression, lack of motivation, severity of deficits) and external factors (limited family support, program difficulty, lack of Spanish language resources). SLPs identified multiple factors influencing HEP adherence. Clinicians should consider these factors when developing HEPs for PWA. https://doi.org/10.23641/asha.32484204.

Hospital quality leaders and clinicians in urology receive conflicting signals from hospital rankings, such as the US News & World Report (USNWR), which reports prostatectomy patients to target for quality improvement. Our objective was to develop a clinically coherent cohort definition for radical prostatectomy spanning inpatient and outpatient settings and to assess overlap with USNWR prostate cancer surgery cohorts. This is a cross-sectional, multisite study of all consecutive radical prostatectomies performed within a large, integrated US health system in 2024. We created an institutional definition of prostate cancer surgery inclusive of inpatient and outpatient procedures across all payers, requiring an ICD (International Classification of Diseases)-10 diagnosis code for prostate cancer (C61) plus a procedural code for radical prostatectomy (Common Procedural Terminology 55810, 55812, 55815, 55840, 55842, 55845, or 55866, or ICD-10 procedure codes with clinical confirmation). We then reconstructed the 3 USNWR prostate cancer surgery cohorts: (1) outpatient volume, (2) outpatient potentially preventable complications, and (3) inpatient measures. Our main outcome was percent agreement between the institutional prostatectomy cohort and each USNWR comparator cohort. Only 716/1591 (45%) radical prostatectomies performed at our institution were captured in at least 1 USNWR definition, 613/1591 (39%) were captured by the USNWR potentially preventable outpatient complications definition, and 97 (6.1%) were captured by the inpatient outcomes definition. USNWR prostatectomy cohorts capture less than half of clinically relevant cases. More inclusive, clinically coherent definitions-such as our institutional cohort-are needed to reliably benchmark hospital performance in radical prostatectomy.

Multiple psychological factors and related comorbidities affect children with chronic pancreatitis (CP) or acute recurrent pancreatitis (ARP). We aimed to describe the frequency of psychological symptoms/diagnoses in children with CP/ARP and predict the severity of the disease burden based on these factors. We retrospectively identified patients aged 5 years or younger with a prior history of CP/ARP who were evaluated by a pediatric psychologist as part of their evaluation for total pancreatectomy with islet autotransplantation (TPIAT) at a single center. Symptoms of psychological disorders and prior psychological diagnoses were identified. Patients and their families completed pain questionnaires as part of clinical care. Demographic and pancreatic disease data were collected from electronic medical records. Of 105 children (mean age 12.1 ± 3.5y, 54.3% females, 84.4% white), 37.1% had a psychological diagnosis [20.0% anxiety, 13.3% depression, 23.8% attention-deficit hyperactivity disorder (ADHD), 4.8% post-traumatic stress disorder (PTSD)] while 86.7% displayed symptoms based on DSM-5 criteria (75.7% anxiety, 32.3% depression, 21.1% suicidal ideation, and 40.2% panic). Regarding pain, 38.8% of patients reported daily abdominal pain, 24.3% weekly, 14.6% monthly, and 22.3% less than once per month. In the 6 months prepsychology appointment, 70.9% used opioids in the inpatient setting, 25.7% used opioids in the outpatient setting, and 45.2% were on a neuromodulator to control their pain. The median pain severity did not statistically differ by psychological diagnosis or symptoms ( P =0.16). There was a high prevalence of psychological diagnoses/symptoms in patients with ARP/CP, including suicidal ideation. This highlights the need for future prospective studies to explore the role of mental health in disease outcomes in children with CP or ARP.

Psychiatric disorder diagnoses and adverse psychiatric outcomes among pregnant and postpartum adolescents in Ontario, Canada: a retrospective, population-based cohort study.

Challenges in the diagnosis and treatment of endometriosis from the perspective of healthcare providers in Germany: A qualitative study.

Suicidality and depression in patients with Epilepsy: provider education module and patient screening in an outpatient clinic setting.

Background: Ciltacabtagene autoleucel (cilta-cel) was approved for patients with relapsed or refractory multiple myeloma who received 1-3 prior lines of therapy in April 2024. Although traditionally administered inpatient (IP), there is an increasing trend in outpatient (OP) cilta-cel administration. However, few studies have quantified the healthcare resource utilization (HCRU) and cost implications of OP versus IP administration in clinical practice. Aim: To compare HCRU and costs following OP versus IP administration of cilta-cel among patients with relapsed or refractory multiple myeloma after 1-3 prior lines of therapy. Materials & methods: This retrospective observational study used the Loopback Analytics electronic medical records database (28 February 2017 to 30 June 2025). We classified patients into OP or IP cohorts. All-cause and multiple myeloma-related HCRU and per-patient-per-month imputed costs were compared over 30 and 90days post-infusion. Results: There were 99 patients included (OP: 37; IP: 62). In the first 30days post-infusion, 40.5% of the OP cohort did not require IP admission. Compared with the IP cohort, the OP cohort had significantly lower all-cause IP days (adjusted incidence rate ratio: 0.31; p<0.001) and significantly lower all-cause IP-related imputed costs (adjusted mean difference: -$39,786; p<0.001). Results were consistent over the first 90days post-infusion and for multiple myeloma related HCRU and costs. Overall, OP administration was associated with an estimated cost savings of approximately $40,000 and $53,000 per patient in the first 30 and 90days post-infusion, respectively. Conclusion: OP administration of cilta-cel was associated with significantly lower IP resource utilization and imputed costs over the first 3months post-infusion relative to IP administration, supporting the potential economic value and adoption of OP cilta-cel delivery.

To evaluate postpartum type 2 diabetes testing and classification using the revised 2022 American Diabetes Association (ADA) diagnostic criteria, in comparison with the American College of Obstetricians & Gynecologists' (ACOG) criteria, in women with gestational diabetes mellitus (GDM) across inpatient and outpatient testing settings. Secondarily, we aimed to evaluate whether the timing of administration of the screening test was associated with differences in results. This was a retrospective cohort study of patients with GDM who delivered at a single institution between 2023 and 2025. The traditional cohort (January-December 2023) was recommended an outpatient 75-g, 2-hour oral glucose tolerance test (OGTT). The hybrid cohort (June 2024-June 2025) was given the option of inpatient screening during the delivery hospitalization or outpatient testing. The primary outcome was OGTT completion. Secondary outcomes were diagnoses of glucose intolerance or diabetes. In January 2022, the ADA revised postpartum diagnostic criteria so that a diabetes diagnosis would require two abnormal values instead of a single abnormal OGTT value. The ACOG and 2022 ADA criteria were applied to OGTT results retrospectively to estimate their effect on postpartum diabetes classification. In a subgroup analysis, we examined whether the timing of postpartum OGTTs influenced the results. In the traditional cohort, 6,689 deliveries occurred; of these, 309 patients (4.6%) had GDM and met inclusion criteria. In the hybrid cohort, 6,312 deliveries occurred; of these, 276 (4.4%) patients met inclusion criteria. Rates of OGTT completion were higher in the hybrid cohort than in the traditional cohort (73.9% vs 31.7%, P <.001). Inpatient testing yielded higher rates of glucose intolerance (48.0%) and diabetes (15.4%) than outpatient testing in either cohort (traditional: 19.4% glucose intolerance and 4.1% diabetes; hybrid: 20.7% glucose intolerance and 3.4% diabetes). Application of the 2022 ADA criteria resulted in the reclassification of most ACOG-defined diabetes results as glucose intolerant (Bowker χ 2 =24, P <.001). In an adjusted multinomial regression that used ACOG criteria, inpatient testing was associated with glucose intolerance (adjusted odds ratio [aOR] 3.06; 95% CI, 1.57-5.97) and overt diabetes (aOR 4.65; 95% CI, 1.14-18.9) when compared with outpatient testing. Testing on postpartum day 1 relative to outpatient testing was associated with glucose intolerance (aOR 2.20; 95% CI, 1.36-3.57) and overt diabetes (aOR 3.92; 95% CI, 1.69-9.06), whereas testing on or after postpartum day 2 did not show a statistically significant association. Inpatient screening improves the rate of postpartum testing, but diagnostic classification varies widely by the criteria used (ACOG vs ADA) and test timing (postpartum day 1 vs 2), which underscores the need for national guidance on optimal timing and interpretation of postpartum OGTTs.

A retrospective review. To perform a comparative cost analysis of unilateral biportal endoscopic surgery (UBE), uniportal endoscopic surgery, microtubular surgery, and open surgery in outpatient and inpatient settings. Endoscopic spine surgery techniques have gained traction for their benefits. However, the relative costs of biportal and uniportal endoscopic approaches compared with traditional methods, such as microtubular and open spine surgery, remains a debated topic. An evaluation of cost implications is critical for health care providers and policymakers when considering the most economical and effective surgical options for patients requiring spine surgery. The surgical logs of 2 spine surgeons were analyzed to identify patients who underwent primary, single-level lumbar discectomy utilizing biportal endoscopic lumbar microdiscectomy, uniportal endoscopic lumbar microdiscectomy, tubular lumbar microdiscectomy, or open lumbar microdiscectomy between January 2022 and March 2024. For each case, a specified list of medications, surgical supplies, and labor costs was obtained and analyzed. In total, 195 surgeries were chosen for cost analysis with 88 patients in Group A, 61 patients in Group B, 41 patients in Group C, and 5 patients in Group D. Using tubular surgery as the baseline, uniportal endoscopic surgery (Group D) was the most expensive, with nearly 2.5× the cost of tubular surgery across settings. Biportal endoscopic surgery (Group A) had costs spanning from 1.14 to 1.6, with a group mean of 1.23, making it more costly than both tubular (Group B) and open surgery (Group C). Open surgery had slightly greater costs than tubular, with a group average of 1.09. Relative costs were consistent across settings. Uniportal endoscopic surgery was determined to have significantly higher costs. UBE had moderately higher costs but remained the more economical endoscopic approach.

Prevalence of human T-lymphotropic virus type 1 (HTLV-1) infection among patients attending a dermatology clinic in Northeastern Brazil.

Facial rejuvenation increasingly uses techniques targeting the Superficial Muscular Aponeurotic System (SMAS) for natural, durable results. Advances in anesthesia, especially tumescent local anesthesia (TLA), have enhanced the safety and recovery of complex aesthetic procedures. This study evaluates the efficacy and safety of SMAS plication facelift, platysmaplasty, and neck liposuction under TLA in an outpatient setting over the past decade. Between 2012 and 2022, eighty ASA I-II patients (mean age 56, range 47-65) underwent SMAS plication facelift, midline platysmaplasty, and submental liposuction under TLA. Preoperative workup included blood tests, ECG, and cardiology clearance. The tumescent solution (25mL 2% lidocaine, 8mEq sodium bicarbonate, 1 mL epinephrine in 1000mL saline) was infiltrated at 100mL per hemiface. Midazolam sedation was administered as needed. Surgical time averaged 150min, including 40min for TLA. Patients were monitored for three hours postoperatively and followed up to 36 months. The mean infiltrated volume was 200mL per patient. There was no lidocaine or epinephrine toxicity, and no conversions to general anesthesia (GA). Over 36months, complications occurred in 10%: hematoma (2.5%), seroma (1.25%), scarring (3.75%), paresthesia (1.25%), and "pixie ear" (1.25%). No infections or anesthesia-related events were observed. Patients reported high satisfaction, rapid recovery, and minimal discomfort. TLA effectively replaces GA for SMAS plication facelift with platysmaplasty and neck liposuction. It offers sufficient analgesia, supports precise dissection with less bleeding, and minimises postoperative edema and ecchymosis, leading to quicker recovery and improved patient comfort and satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Facial aesthetic surgery is increasingly performed under local anesthesia, with or without sedation, in office-based settings. This systematic review and meta-analysis aimed to determine the safety profile of such procedures by measuring the incidence of complications following facial cosmetic surgery under local anesthesia, with or without sedation. A systematic review of the literature was performed in line with the PRISMA guidelines. The databases PubMed, Embase, Scopus, CINAHL, and Web of Science were searched. Studies reporting on complications following facial cosmetic surgery performed in outpatient settings under local anesthesia, with or without sedation, were included. The pooled weighted incidence of complications was calculated using a random-effects inverse variance model with Freeman-Tukey transformation. Twelve studies were included, with a procedure pool of 3283. The incidence of total complications was 5.6%, 95% CI [2.8, 9.3]. The incidence of major complications was 1.6%, 95% CI [0.1, 4.3], while minor complications occurred in 3.7%, 95% CI [2.0, 5.7], of cases. Combined facial aesthetic procedures were uncommon, with 9% of patients undergoing multiple procedures in the same operative setting. Facial cosmetic surgery under local anesthesia, with or without sedation, appears to be associated with a low incidence of complications. Combined procedures were uncommon, indicating that operative scope in these settings is generally limited. Substantial heterogeneity among studies underscores the need for standardized definitions of complications, anesthetic protocols, and evidence-based patient selection criteria. Future research should focus on developing these frameworks and incorporating validated outcome measures to further optimize safety and patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract Purpose This prospective study aimed to develop a predictive score for obstructive sleep apnea (OSA) risk using participants' somesthetic perception of airflow in their oropharynx. The primary goal was to establish a two‐step clinical screening protocol: first, using participants' somesthetic information, then integrating additional clinical observations. Methods The assessment involved two phases. First, mechanical modifications of the oropharynx were induced by experimenters, in its volume and wall tension to create either “facilitating” or “aggravating” airflow conditions. Participants' somesthetic response accuracy was scored by item, yielding an intermediate score (IS) of 0–13. Second, anatomical and clinical observations were added to the IS to produce a total score (TS) ranging from 0 to 23. The study included 101 participants: 41 undergoing polysomnography (PSG), categorized by OSA severity, and 60 controls. Results A two‐part score was obtained. Obstructive sleep apnea suspicion thresholds were IS ≥ 7.5 and TS ≥ 10. Sensitivity was 73% for IS and 80% for TS; specificity was 77% for IS and 70% for TS ( p &lt; 0.001). Conclusion This study established a clinical score for OSA suspicion using participants' oropharyngeal airflow perception, offering a complementary, low‐cost method for identifying at‐risk OSA patients in outpatient settings. Clinical Trial Registration Registered at clinicaltrials.gov, ID: NCT06092710, URL: https://clinicaltrials.gov/study/NCT06092710 .

This retrospective matched case-control study aimed to identify potential risk factors associated with the development of dental abscesses during or after endodontic treatment. The study analyzed data from 133 patients (74 males, 58 females; mean age 43.1 ± 16.5 years) with abscess formation of endodontic origin and compared them with a 1:1 matched control group without abscess. Matching was performed based on age and the specifically treated tooth. Collected variables included preoperative symptoms, radiographic findings, type and stage of endodontic intervention, and systemic medical conditions. Statistical analysis used chi-square or Fisher exact tests to compare between groups. STROBE and PROBE guidelines were followed. Among 2637 maxillofacial infections of odontogenic origin, 526 cases (19.9%) were related to endodontic treatment. No statistically significant associations were found regarding age, sex, or underlying systemic diseases (p > 0.05). Teeth exhibiting apical radiolucency were at significantly higher risk for abscess development (p < 0.001). Teeth that had undergone definitive root canal filling were significantly less likely to develop abscesses compared to those left without temporary filling after trepanation (p < 0.001) or treated with intracanal medication and temporary filling (p = 0.009). The highest incidence of abscess formation was observed within the first four days post-treatment (p < 0.001). Within the limitations of this retrospective study, abscess formation during or after endodontic treatment was linked to local procedural and radiographic factors, whereas systemic diseases did not demonstrate a measurable influence. The absence of temporary sealing and the presence of apical radiolucency were identified as significant risk indicators and may warrant increased clinical attention, particularly in the early postoperative period. Given the retrospective design and limited sample size, these findings should be interpreted with caution and require confirmation in prospective studies.

Radiation Segmentectomy versus Combined Chemoembolization plus Microwave Ablation: Histopathologic Tumor Necrosis in Hepatocellular Carcinoma Measuring up to 5 cm.

Sotalol is a class III anti-arrhythmic medication commonly used in maintaining sinus rhythm in patients with arrhythmias, most notably atrial fibrillation. Sotalol is conventionally initiated in an inpatient setting (typically three days) to allow close monitoring of its effects, particularly corrected QT interval (QTc) prolongation, which may predispose patients to fatal arrhythmias such as torsades de pointes. In this meta-analysis, we aimed to assess the safety of initiating sotalol in an outpatient setting. We searched PubMed, Scopus, Embase, Cochrane Library, Web of Science, Virtual Health Library, and Google Scholar for observational studies and randomized controlled trials assessing the safety of outpatient initiation of sotalol until July 2025. Our endpoints were the change from baseline in QTc interval at the longest follow-up and the rate of sotalol discontinuation due to adverse events. Standardized mean differences from baseline in QTc interval with 95% confidence intervals were pooled with a random-effects model using CMA V3 software. We included three observational studies with a total cohort of 1248 patients. At the longest follow-up post-sotalol initiation in an outpatient setting, there was no statistically significant change in QTc interval from baseline (SMD=+0.15, 95% CI: -0.357 to 0.658, p=0.56). Across 1140 patients, the rate of drug discontinuation due to adverse events at one-month post-sotalol initiation ranged from 4.7% (41/880 patients; 95% CI 3.4%-6.3%) in one study to 8.1% (21/260 patients; 95% CI 5.3%-12.1%) in another. In carefully selected patients, the initiation of sotalol in an outpatient setting appears to be safe and associated with no significant adverse events. However, the current evidence is limited to a small number of observational cohorts, and large randomized controlled trials are warranted to establish the safety and efficacy of outpatient sotalol initiation.